| NPI | 1124438668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31638) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001361) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2020-01-01 |